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Indications, complications, and surgical techniques for pediatric tracheostomies--an update
B Kremer1, A I Botos-Kremer, H E Eckel
1Department of Otorhinolaryngology, Head and Neck Surgery, University of Maastricht, The Netherlands.
Insights
Pediatric tracheostomy indications are shifting towards long-term ventilation and congenital anomalies. A specialized surgical technique, creating a cartilage window, may reduce fatal complications like cannula obstruction and decannulation in children.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Critical Care Medicine
Background:
- The role of pediatric tracheostomy is evolving due to advances in intensive care and a decline in life-threatening airway infections.
- Long-term endotracheal intubation and congenital anomalies are increasingly common indications for pediatric tracheostomy.
Purpose of the Study:
- To analyze current indications, complications, and techniques for pediatric tracheostomy.
- To provide data reflecting the contemporary scientific landscape of pediatric tracheostomy.
Main Methods:
- A comprehensive review of international literature on pediatric tracheostomy.
- Analysis of the authors' personal experience with 25 pediatric patients (under 6 years) operated on between 1980 and 1996.
Main Results:
- Literature shows heterogeneity in terminology, patient groups, techniques, indications, and complications.
- Tracheostomy indications have shifted from inflammatory diseases to long-term ventilation and congenital anomalies.
- Common complications include pneumomediastinum, pneumothorax, wound issues, bleeding, granulations, and tracheal stenosis; fatalities are often linked to the underlying condition.
Conclusions:
- The study's findings align with existing literature, but no tracheostomy-related deaths occurred in the authors' cohort.
- Implementing a cartilage window technique may facilitate cannula exchange and mitigate the risk of fatal accidental decannulation.
- Continuous monitoring, including fiberoptic assessment, is crucial for children undergoing prolonged ventilation via tracheostomy.
Background:
With the decrease of life-threatening obstructive upper airway infections and the ongoing improvement of intensive care medicine, the role of tracheostomy in children has been changing considerably, until now. The aim of this study was to establish data regarding indications, complications, and techniques of pediatric tracheostomy, which would reflect the current state of science.
Methods:
The authors analyzed the international literature as well as their own experience with 25 children less than 6 years of age who were operated on between 1980 and 1996.
Results:
Literature proved to be very heterogeneous in terms of terminology, patient groups, operation techniques, indications, and complications. Within the past decades, long-term intubation and congenital anomalies of the upper respiratory tract have become increasingly prevalent, whereas inflammatory diseases were less and less an indication for tracheostomy. Endotracheal intubation as an alternative has resulted in less frequent tracheostomies in general. Today, children can be ventilated for months without considerable complications. However, individual, clinical, and fiberoptical controls are necessary. Tracheostomy-related complications have not changed significantly. Fatalities are mostly caused by the underlying disease. The most frequent causes of tracheostomy-related death are cannula obstruction and accidental decannulation. The most frequent early complications are pneumomediastinum, pneumothorax, wound complications, and bleedings. Subsequent complications most often are granulations and tracheal stenosis.
Conclusions:
The authors' research agreed widely with that in the literature. However, no tracheostomy-related death occurred. Possibly, this was because of their operative technique. In the opinion of the authors, establishing a cartilage window facilitates cannula exchange and reduces the risk of a fatal accidental decannulation.